• Richard Cree

Nicky's First Night Shift

Updated: Apr 2, 2020

Thursday 26 March 2020

COVID Figures for 25 March

UK Deaths 43 / Total 465

James Cook Hospital Critical Care - 10 cases (3 suspected) / 5 ventilated

Nicky returns from her night shift. Not too many sick patients but due to the high state of anxiety in parts of the hospital she was kept busy until 0500hrs.

The good news is that two of our COVID patients have recovered and have been discharged to the ward. The bad news is that this efflux rate is clearly way below the increasing influx rate.

There is a lot of fear amongst staff not used to dealing with acutely ill patients. The recent deaths of young patients that have been reported in the media have not helped this situation. There are still many members of staff who have not been tested for protective FFP3 masks and they, understandably do not want to go near any COVID patients.

The critical care team was called to one of the surgical wards last night. There were two patients who had been admitted with acute surgical problems and initially showed no signs of the virus. Over the preceding few hours they had both developed a cough. They had home CPAP machines (the ones people use for Obstructive Sleep Apnoea) and they routinely slept with these masks on. Because CPAP in hospital is considered an 'aerosol-generating procedure' and associated with high-risk of viral transmission, the nurses were refusing to look after them. Reassurances that the patients systems were low-flow unlike the hospital high-flow ones fell on deaf ears and the bay the patients were in was evacuated. The patients were left to fend for themselves. No nurses would enter the area. When the ICU registrar attended in an effort to reassure the staff, she had to help one of the patients onto a commode because the nurses refused without protective gear!

This sort of attitude is not helpful.

Just when Nicky was beginning to feel that her entire shift had been occupied by the mundane, a 51 year old man presented to A&E in extremis. He had severe respiratory failure, almost certainly due to COVID-19 and was about to stop breathing. Immediate intubation was performed in the A&E 'shower' (without incident this time) and he was transferred up to the ICU for ventilation. Whilst most of our cases seem to be patients who deteriorate in hospital, this was a timely reminder that some cases can become desperately ill at home with a risk of out-of-hospital respiratory arrest.

Nicky headed home and surprisingly was able to buy a reasonable quantity of food and milk from the Spar en route. Still no toilet roll though. She quickly said hello to the children and headed to bed leaving me to mop up the tears of my eldest as she complained about the amount of schoolwork she had been set...

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